Improving Pre-Kidney Transplantion Laboratory Utilization in an Era of Increasing Waitlist Size
1Pathology, Massachusetts General Hospital, Boston, MA, 2Transplant Surgery, Massachusetts General Hospital, Boston, MA, 3Nephrology, Massachusetts General Hospital, Boston, MA
Meeting: 2019 American Transplant Congress
Abstract number: C6
Keywords: HLA antibodies, Kidney transplantation, Screening, Waiting lists
Session Information
Date: Monday, June 3, 2019
Session Name: Poster Session C: Histocompatibility and Immunogenetics
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Beginning on March 25, 2015, our institution’s kidney transplant program has implemented a “readiness” protocol, whereby patients are listed after limited workup and comprehensive testing is deferred until the anticipated time to transplantation is approximately 6-12 months. Prior to implementation of this protocol, our histocompatibility laboratory would receive monthly sera for anti-HLA antibody screening immediately upon listing. However, as part of the readiness strategy, the lab now requests monthly samples only when a candidate is predicted to have 6-12 months of waitlist time remaining.
*Methods: Data from our laboratory database and UNOS were analyzed to determine the number of samples received from waitlisted kidney transplant candidates and the number tested in the three-year period before and after implementation of the readiness protocol.
*Results: Our kidney transplant waitlist has grown from 379 candidates in 2012 to >1000 in 2018. Despite this rapid growth, the number of samples received from kidney transplant candidates has decreased from 9171 during the three-year period prior to the implementation of readiness (~3057/year) to 7924 during the subsequent three-year period (~2641/year). Based on a sample submission rate of ~7 samples/patient/year, an estimated 5425 samples per year would have been received without the readiness protocol, with an estimated 6979 samples expected for 2018. From 3/25/12-3/24/15, 4730 antibody screening tests on kidney waitlist candidates were performed by Luminex (~1577 tests/year), compared to a slight increase to 5082 from 3/25/15-3/24/18 (~1694 tests/year), despite a 2.6-fold increase in patients on the waitlist from 2012-2018. When adjusted for the number of waitlist candidates in each time period, the percentage of candidates being passed over for an organ offer due to an 812 code (no serum sample) is comparable before and after readiness.
*Conclusions: Implementation of the readiness protocol has streamlined the pre-transplant testing process and reduced both the number of samples received and the number tested, with minimal effect on missed organ offers due to lack of a current sample. This strategy has allowed us to manage a greatly increased waitlist with the same level of resources and has resulted in reduced cost per patient.
To cite this abstract in AMA style:
Mahowald GK, Kimball B, Elias N, Heher E, Girouard T, Saidman SL, Pattanayak V. Improving Pre-Kidney Transplantion Laboratory Utilization in an Era of Increasing Waitlist Size [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/improving-pre-kidney-transplantion-laboratory-utilization-in-an-era-of-increasing-waitlist-size/. Accessed December 13, 2019.« Back to 2019 American Transplant Congress